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Implementing a Quality Improvement Program at a Community Medical CenterResearch Paper

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¶ … Quality Improvement Program at a Community Medical Center Designed to Reduce Foley Catheter Days and the Incidence of Catheter Associated Urinary Tract Infections (CAUTIs)

It is estimated by the United States Centers for Disease Control and Prevention (CDC) that about 2 million health care-associated infections take place every year. These infections bring about 99,000 deaths and roughly $40 billion in additional health care expenses. Shockingly, these statistics reveal that more deaths result from healthcare-associated infection (HAI) than the total combined deaths from Acquired Immuno-Disease syndrome (AIDS), breast cancer, and auto accidents. Given these facts, it is imperative to take note that majority of the HAIs are preventable.

The most common type of healthcare-associated infection is referred to as Catheter-Associated Urinary Tract Infections (CAUTI). Health problems which are associated with this HAI result in extended length of stay, patient distress (including pain and discomfort as well as emotional distress), increased health care expenses, and death. Every year, it is estimated that about 560,000 cases of CAUTI take place, resulting in increased and/or excess health care expenses as well as mortality (Anderson et al. 2007; Klevens et al. 2007). Tackling and reducing CAUTI is part of the nation's HAI initiative; the purpose is to save up to $35 billion in terms of health care expenses, comprising $10 billion set out for Medicare. In medical institutions, CAUTIs are the most prevalent kind of HAI in the United States and make up just about 35% of all such types of contaminations (Saint, 2000). According to Klevens et al. (2007), it is estimated that the United States (U.S.) incurs a cost of about $565 million for CAUTI and the resulting estimated annual death rate is 13,000 every year.

Preventing CAUTI

The systems of care, as well as those hospitals that have been most fruitful in attaining and sustaining reductions in infection rates, have generally employed a two-pronged method that makes use of the best clinical practices along with a change in culture. There are clear and comparatively straightforward scientific or practical interventions to reduce CAUTI. Nonetheless, wholly incorporating these best practices into standard procedures of operation appears to be problematic, and beset with difficulties and intricacies within the care setting. Making use of technical interventions to reduce CAUTI necessitates a concurrent and synchronized ethnic and/or adaptive method to generate a care environment that enables and boosts development (American Hospital Association, 2013).

Clinical CUSP (Comprehensive Unit-based Safety Program)

Systems of care, including hospitals, can attain pronounced change and positive impact by enhancing patient safety and quality care simply by instigating an organizational culture of safety. This organizational culture should also be entrenched in evidence-based technical interventions. A 'safety-oriented' organizational culture decreases mistakes and errors, and also improves the level of communication amid hospital personnel, workers, and patients (including their families). The Comprehensive Unit-based Safety Program (CUSP) model generates a fundamental basis or groundwork for medical doctors, nurses, other clinical care team members, and subsidiary divisions to function and operate together (AHRQ).The context for fighting CAUTI would consist of the following as a unit management viewpoint:

i. Bringing the team together

Each unit-based team focused on the improvement of safety ought to have an acknowledged team leader, members of different points-of-view, and a majority of members who offer direct care.

ii. Involving the Senior Executive

It is the role and work of the senior leader to talk about issue(s) dealing with safety that have been acknowledged by the unit teams and caregivers; this should focus on doing away with obstacles to enhancement.

iii. Comprehending the aspect of safety

The delivery of care is done through intricate systems and structures; input is required from the front-line caregivers to take into account safety flaws at the system level.

iv. Detect and learn from Shortcomings

This encompasses specific examples concerning what has happened within and around the unit that was deemed to be erroneous, or not 'best practice', and that would not be desired to occur repetitively. More so, it covers primary causes of CAUTI (and other issues) that can be taken into consideration to ensure safer care

v. Executing teamwork and tools for communication

Hands-on and everyday models for teamwork and tools for communication can be employed to take into account the issues that might hinder dangers to safety.

Aspects to consider prior to inserting the catheter

Prior to the insertion of an indwelling catheter, it is imperative to take into consideration whether these alternatives would be more suitable:

i. Bladder scanner to evaluate and provide confirmation of urinary retention prior to inserting the catheter in order to release urine (OHTAS)

ii. Bedside garments such as those of assisting continence, and provision of urinal with the purpose of managing incontinence iii. Straight catheter for one-time, irregular, or protracted emptying needs.

iv. External catheter, also referred to as condom catheter. This is suitable for obliging men devoid of any urinary retention or any form of impediment (Saint et al., 2006).

Technical Interventions for CAUTI Prevention

Evidence that is obtained clinically is employed to offer guidance for CAUTI prevention. The following are major steps which hospitals ought to concentrate on:

i. Suitable use of urinary catheter

The main components of the Appropriate Catheter Placement Intervention include:

1. The insertion of urinary catheters should only be for suitable indications. The evidence-based HICPAC/CDC Policy stipulates appropriate suggestions for urinary catheter insertion and use.

2. Take into consideration the different alternatives to in-dwelling urinary catheters; these include using bladder scanners to detect and supervise urinary retention, external catheters, and approaches to measuring output of urine that are non-invasive.

ii. Proper catheter insertion and maintenance

The main components of the Proper Insertion and Maintenance Intervention consist of:

1. Making sure that only well trained personnel who are certain of the appropriate method of sterile catheter insertion, as well as catheter maintenance, are handed these duties

2. Catheters should be inserted through use of hygienic methods and equipment that is sterile

3. Maintenance of a disinfected drainage system that is always closed

4. Ensure that the urinary drainage system is not disconnected to the catheter unless the latter ought to be irrigated physically due to hindrance and impediment.

iii. Timely removal of the catheter

The catheters ought to be removed as soon as possible. There should be daily monitoring and supervision of any patients using catheters. If by any chance, a suitable indication for catheter use is not existent anymore, then there should be the timely removal of the catheter. It is important for doctors and nurses to be wary of the indications for the use of urinary catheters; these medical professionals ought to repeatedly monitor and supervise patient need for a catheter. Doctors ought to quickly withdraw catheters that are not indicated or needed anymore; nurses assessing catheters and discovering no indication ought to communicate with the doctor to quickly discontinue or withdraw the catheter. One common reason for the improper and unfitting use of catheters is simply the lack of awareness and alertness amongst clinicians using catheters. In one research study, eighteen percent of medical students, twenty two percent of medical interns, twenty eight percent of medical residents, and thirty five percent of attending physicians did not observe or take into consideration that their patients had an indwelling catheter (Saint, Weiss and Amory J. K, et al., 2000).

iv. Training of Personnel

Make certain that only well-trained personnel, who are well informed about the proper method of sterilized catheter insertion, and its maintenance, are given the duty and accountability for placement or insertion of the urethral catheters. The following are materials which are required for inserting urethral catheters:

1. Sterile gloves

2. Underpads that are water absorbent

3. Aseptic drape

4. Forceps

5. Swabs for preparation

6. Antiseptic solution

7. Catheter

8. Tubing

9. Collecting bag

10. Aseptic water for inflating the balloon

11. Lubricating jelly

Plenty of the above mentioned supplies can be bought as kits which are already prepackaged. The catheters widely and largely differ in terms of design, size, as well as material. The most commonly used catheter is the Foley catheter. Others include the straight-tip as well as double-lumen catheters.

All the urethral catheters have to be placed under aseptic conditions at all times and while wearing gloves which are sterile. If a catheterization kit is being used, first off it has to be removed from its external packaging, and thereafter open the paper wrapping inside to create an aseptic field. In order to ensure that the gloves are not contaminated, the absorbent pad ought to be retrieved in a careful manner from the top of the kit with cleansed hands and thereafter placed underneath the buttocks of the patient with the plastic being side down. The gloves should then be put on and the greater pubic area and the abdomen of the patient covered with the drape. The content of the tray should be placed on an area that is sterile and on a bedside table that can be easily reached and the tray should be well… [END OF PREVIEW]

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